title: Biomechanical evaluation of flexor tendon repair using barbed suture material: a comparative ex vivo study.
abstract: OBJECTIVE
  Barbed suture material for tendon repair opens up the possibility of a knotless reconstruction due to an increased suture-tendon interaction. The aim of this study was to compare the tensile strength of a knotted technique with a monofilament polydioxane suture to that of a knotless technique with a barbed suture material, by using a multistrand, modified Kirchmayr-Kessler tenorrhaphy.
  
  
  METHODS
  Sixty human flexor digitorum tendons were randomized into 4 groups. A modified, knotted, multistrand Kirchmayr-Kessler technique with an absorbable, monofilament polydioxane suture was compared with a modified, knotless, multistrand Kirchmayr-Kessler technique with an absorbable, unidirectional barbed glycolic-carbonate suture. Tendons were distracted to failure. Mode of failure and load to failure were recorded.
  
  
  RESULTS
  The knotless 2-strand Kirchmayr-Kessler barbed suture shows a significantly lower tensile strength than the knotted 2-strand polydioxane suture (p < .001). The comparison of the maximum tensile strength of the knotless (glycolic-carbonate) technique with that of the knotted (polydioxane) 4-strand technique resulted in no significant difference in either technique utilized (p = .737). The tensile strength of the 4-strand technique was greater than that of the corresponding 2-strand technique (p < .001).
  
  
  CONCLUSIONS
  The 2-strand Kirchmayr-Kessler barbed suture proved to be insufficient and significantly weaker than the 2-strand polydioxane suture, and therefore it cannot be recommended. With the knotless 4-strand Kirchmayr-Kessler technique, the barbed suture material has the potential to be used in flexor tendon surgery, but it has no advantage over the 4-strand polydioxane suture.
authors.affiliation: Wuerzburg University Hospital, Department of Trauma, Hand, Plastic and Reconstructive Surgery, Wuerzburg, Germany. zeplin_p@chirurgie.uni-wuerzburg.de
authors.forename: Philip H
authors.initials: PH
authors.lastname: Zeplin
authors.forename: Robert K
authors.initials: RK
authors.lastname: Zahn
authors.forename: Rainer H
authors.initials: RH
authors.lastname: Meffert
authors.forename: Karsten
authors.initials: K
authors.lastname: Schmidt
mesh_terms: D020341:Absorbable Implants; D004146:Dioxanes; D006225:Hand; D006801:Humans; D066298:In Vitro Techniques; D011108:Polymers; D013536:Suture Techniques; D013537:Sutures; D013710:Tendons / Q000601:surgery*; D013718:Tensile Strength
chemical_list: D004146:Dioxanes; D011108:Polymers; C542571:polydioxane sulfate; C046409:polyglyconate